In an article for MED TECH Outlook magazine, Professor Prokar Dasgupta looked at three forces shaping the future of robotic surgery: cost, connectivity and artificial intelligence. Each could change how widely robotic surgery is available and how it is performed. This article summarises his views on robotic surgery cost, AI and 5G, and what they may mean for patients.
A growing choice of robots
For many years, the da Vinci surgical system has been the leading robot for soft tissue surgery. It is now facing competition from international companies developing their own next-generation systems.
At the time of writing, The London Clinic was the only private hospital in the UK with four robots: the da Vinci Xi for several specialties, Navio for orthopaedics, a waterjet robot for benign prostatic enlargement and the ExcelsiusGPS for spinal surgery. To challenge the current standard, new systems will need to be at least as good, or significantly cheaper, so that more hospitals can afford them. Open consoles, enhanced 3D vision, lighter instruments and greater portability are common themes. Greater competition may also encourage faster innovation across the field.
Renewed interest in automation
Some researchers are revisiting automation, an idea that goes back to the pioneering work of John Wickham. In an animal study, a system called the Smart Tissue Autonomous Robot, or STAR, was able to stitch bowel more accurately than a human hand.
The waterjet robot for benign prostatic enlargement takes inspiration from Wickham's early prostate robot. It may offer an alternative to traditional prostate operations without such a steep learning curve for surgeons. Our page on Aquablation therapy explains how this treatment works.
Bringing costs down
New machines have the potential to bring the cost of robotic surgery closer to that of standard keyhole surgery, although the initial investment may still be substantial. Some companies now offer packages covering maintenance, instruments and support, which could make robotics attractive to more surgical teams. Our article on the Versius robot describes one such system in NHS use.
Artificial intelligence
The concept of artificial intelligence is not new; it goes back to Alan Turing, whose code-breaking work had a major impact during the Second World War. Machine learning, a branch of AI, uses algorithms that learn from data.
In prostate cancer, an algorithm could learn to recognise cancer on MRI images, reducing variation between the radiologists who read them. Video recordings of robotic prostatectomies can also be converted into performance measures. This work has produced a surprising finding: not every high-volume surgeon has the best outcomes. Our article on why surgeon experience matters discusses how experience and results relate.
Governments are investing heavily in AI, but Professor Dasgupta sounded a note of caution. Many published AI studies do not share their code, which makes results difficult to reproduce. Trust in data and ethical safeguards also remain essential.
Faster connections
Augmented reality platforms, surgical data science and fast, low-latency 5G networks could make expert surgical guidance available anywhere. Professor Dasgupta calls this the "Internet of Skills": remote surgery and mentoring, regardless of where the expert surgeon is based. Our article on the UK's first long-distance robotic prostatectomy shows this idea put into practice.
What it means for patients
If these developments succeed, robotic surgery could become more affordable, more widely available and more consistent in quality. For now, the experience of the surgeon and team remains central to good results. Independent information on treatment is available from Cancer Research UK, and the Royal College of Surgeons of England publishes guidance on new surgical technology.
To discuss robotic surgery with Professor Dasgupta, please contact the clinic.